Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 5 ( September-October, 2022 ) > List of Articles

Original Article

Efficacy of Hospital-based Cervical Cytology Screening: A 5-year Audit in a Tertiary Care Clinical Center

Shuchi Agrawal, Monika Agrawal, Nisha Singh, Avinash Agrawal

Keywords : Cervical cancer, Cervical cytology, Epithelial cell abnormalities, Preinvasive lesions, Screening

Citation Information : Agrawal S, Agrawal M, Singh N, Agrawal A. Efficacy of Hospital-based Cervical Cytology Screening: A 5-year Audit in a Tertiary Care Clinical Center. J South Asian Feder Obs Gynae 2022; 14 (5):545-550.

DOI: 10.5005/jp-journals-10006-2134

License: CC BY-NC 4.0

Published Online: 16-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: India shares the huge burden of cervical cancer cases, contributing to nearly one-fourth of cervical cancer deaths worldwide. In wake of World Health Organization (WHO) global strategy to eliminate cervical cancer by 2030, there is a need to shift from opportunistic to population-based screening. Still, with limited resources, it is not feasible in current times. With this in mind, we performed wider hospital-based screening of females presenting to the outpatient department (OPD) of Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India and present its findings. We also studied the spectrum and prevalence of epithelial cell abnormality and its association with clinical parameters such as age, parity, socioeconomic status, and clinical findings. Methods: Sexually active women in the age range of 21–65 years attending OPD for various complaints were screened from January 2015 to December 2019. Cervical cytology reports were retrieved from the hospital records. Demographic details of the patient along with presenting complaints were noted. Data was statistically analyzed using a statistical package for social sciences (SPSS software, version 20.0). The Student's t-test was used for comparison of continuous variables and the Chi-squared test for proportions. Results: A total of 14,510 women were screened; the majority were multiparous, aged 30–50 years. A total of 38.4% of patients presented with a chief complaint of discharge per vaginum, 14.6% with menstrual disturbances, 19% with pain in the abdomen, and 22% with no complaints. There were 0.13% inadequate smears and 8.8% had an inflammatory smear, 4.6% cases showed reactive cellular changes, 5.5% low-grade squamous intraepithelial lesion (LSIL), 1.2% high-grade intraepithelial lesion (HSIL), 1.2% atypical squamous cell of unknown significance (ASCUS), 3.14% atypical squamous cells–cannot exclude HSIL (ASC-H) were of 0.19% and 0.01% (two cases), which were reported as squamous cell carcinoma (SCC). There was a significant correlation between the age of presentation, parity, socioeconomic status, and the presence of epithelial cell abnormality. Conclusions: Cervical cytology is an effective method to screen for precancerous lesions of the cervix, with a wider hospital-based screening of a considerable number of females with cervical abnormalities that may be picked up for early intervention.


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  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209–249. DOI: 10.3322/caac.21660.
  2. Bal MS, Goyal R, Suri AK, et al. Detection of abnormal cervical cytology in Papanicolaou smears. J Cytol 2012; 29(1):45–47. DOI: 10.4103/0970-9371.93222.
  3. Bruni L, Albero G, Serrano B, et al. Human papillomavirus and related diseases in the world. Summary Report 17 June 2019. Available at: http://www.hpvcentre.net/statistics/reports/XWX.pdf. Accessed on: 2 August 2022.
  4. Shanta V, Krishnamurthi S, Gajalakshmi CK, et al. Epidemiology of cancer of the cervix: Global and national perspective. J Indian Med Assoc 2000;98:49–52. PMID: 11016150.
  5. Sherpa AT, Clifford GM, Vaccarella S, et al. Human papillomavirus infection in women with and without cervical cancer in Nepal. Cancer Causes Control 2010;21(3):307–323.
  6. Dhaubhadel P, Vaidya A, Choudhary P. Early detection of precursors of cervical cancer with cervical cytology and visual inspection of cervix with acetic acid. J Nepal Med Assoc 2008;47(170):71–76. PMID: 18709035.
  7. Pradhan N, Giri K, Rana A. Cervical cytology study in unhealthy and healthy looking cervix. N J Obstet Gynaecol 2007;2:42–47. DOI: 10.3126/njog.v2i2.1454.
  8. Sarian LO, Derchain SF, Naud P, et al. Evaluation of visual inspection with acetic acid (VIA), Lugol's iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America J Med Screen 2005;12(3):142–149. DOI: 10.1258/0969141054855328.
  9. Tamrakar S, Chawla C. A Clinical audit of pap smear test for screening of cervical cancer. N J Obstet and Gynaecol 2014;7(2):21–24. DOI: 10.3126/njog.v7i2.11137.
  10. Davey DD, Nielsen ML, Naryshkin S, et al. Atypical squamous cells of undetermined significance: Current laboratory practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med 1996;120:440–444. PMID: 8639046.
  11. Tan KB, Chang SE, Soh VC, et al. Quality indices in a cervicovaginal cytology service: Before and after accreditation. Arch Pathol Lab Med 2004;128:303–307. DOI: 10.5858/2004-128-303-QIIACC.
  12. Sankaranarayanan R, Thara S, Sharma A, et al. Accuracy of conventional cytology: Results from a multicentre screening study in India. J Med Screen 2004;11:77–84. DOI: 10.1258/096914104774061056.
  13. Indian Council of Medical Research ICM. Guidelines for Management of Cervix Cancer. New Delhi: DHR and DG, ICMR; 2010. Available from: http://cancerindia.org.in/wp-content/uploads/2017/11/Operational_Framework_Management_of_Common_Cancers.pdf.
  14. Elhakeem HA, Al-Ghamdi AS, Al-Maghrabi JA. Cytopathological pattern of cervical pap smear according to the Bethesda system in Southwestern Saudi Arabia. Saudi Med 2005;26(4):588–592. PMID: 15900366.
  15. Afrakhteh M, Khodakarami N, Moradi A, et al. Study of 13315 Papanicolau Smear Diagnoses in Shohada Hospital. J Family Reprod Health 2007;1(2):74–78.
  16. Khattak ST, Khattak I, Naheed T, et al. Detection of abnormal cervical cytology by pap smears. Gomal J Med Sci 2006;4:74–77.
  17. Sherwani RK, Khan T, Akhtar K, et al. Conventional Pap smear and liquid based cytology for cervical cancer screening – a comparative study. J Cytol 2007;24:167–172. Available from: https://www.jcytol.org/text.asp?2007/24/4/167/41888.
  18. Almonte M, Albero G, Molano M, et al. Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine 2008;26(Suppl. 11):L16–L36. DOI: 10.1016/j.vaccine.2008.06.008.
  19. de González AB, Sweetland S, Green J. Comparison of risk factors for squamous cell and adenocarcinomas of the cervix: A meta-analysis. Br J Cancer 2004;90(9):1787–1791. DOI: 10.1038/sj.bjc.6601764.
  20. Brinton LA, Hamman RF, Huggins GR, et al. Sexual and reproductive risk factors for invasive squamous cell cervical cancer. J Natl Cancer Inst 1987;79(1):23–30. PMID: 3474446.
  21. Kushtagi P, Fernandez P. Significance of persistent inflammatory, cervical smears in sexually active women of reproductive age. J Obstet Gynaecol India 2002;52(1):124–126. Available from: https://jogi.co.in/storage/articles/files/filebase/Archives/2002/janfeb/2002_124_126_JanFeb.pdf.
  22. Vaidya A. Comparison of pap test among high risk and non-risk females. Katmandu Univ Med J 2003;1:8–13. PMID: 16340254.
  23. Bukhari MH, Saba K, Qamar S, et al. Cytopathological importance of papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix. J Cytol 2012;29(1):20–25. DOI: 10.4103/0970-9371.93213.
  24. Bhojani KR, Garg R. Cytopathological study of cervical smears and co-relation of findings with risk factors. Int J Biol Med Res 2011; 2(3):757–761. DOI: 10.1.1.302.8231.
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